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Obsessive-Compulsive Disorder

You're sure you turned off the oven, but can't stop thinking about it. You worry constantly about germs and being contaminated. Have you ever been plagued by thoughts that won't go away? Are your thoughts or behaviors starting to interfere with your everyday life? If so, it may be time to find out whether you may have obsessive-compulsive disorder.

What Is Obsessive-Compulsive Disorder?

An estimated five million people have or will have obsessive-compulsive disorder (OCD) at some point in their lives.

Sufferers of OCD have recurrent and unpleasant thoughts or are compelled to do certain behaviors repeatedly, sometimes for hours each day. Andrea cannot keep from washing her hands constantly, sometimes 30 or 40 times a day. She is compelled to wash them until they are raw, whether they're dirty or not. She feels she cannot be outdoors too long where there's no sink to wash her hands.

People like Andrea know that their thoughts or behaviors are irrational or excessive, but they feel forced to continue them. The anxiety they feel keeps them from getting rid of these irrational thoughts.

The biggest problem in dealing with this disorder may be that many people know there's something wrong but don't have any idea that it might be OCD. And although in some cases the disorder can severely disrupt a person's life, many people function normally and hide their compulsiveness out of fear or embarrassment.

According to Dr. Fred Penzel, of Western Suffolk Psychological Services, OCD has a very long “latency period,” he time that elapses between when a person is first affected and when they seek treatment. This is partly because they aren't familiar with the disorder, but “also because they fear that if they tell someone about it, they'll be locked up and called crazy. There's a tremendous embarrassment factor,” explains Dr. Penzel.

Another reason many are not diagnosed is that OCD is a relatively unknown disorder, both to general practitioners and psychiatrists. Dr. Penzel sees many patients who have been treated unsuccessfully by other doctors. One of his patients who had spent 17 years in psychoanalysis got better in 12 months after coming to his clinic.

Who Gets OCD?

Children as young as two years old have been diagnosed as having OCD, although the disorder usually begins in adolescence or early adulthood. Two thirds of the reported cases started before the patients were 30 years old, while the other third started before the age of 15.

Researchers are trying to determine the part heredity plays. Although the hereditary connection has not been proven, a high incidence of OCD among family members has been found. In a recent study at Yale, researchers discovered that persons with one OCD parent have a 23 percent chance of getting the condition.

Fortunately, many parents who are treated for OCD learn to recognize the symptoms in their children and bring them in for treatment. “There's a whole new generation out there getting treated earlier than they ever did in the past,” says Dr. Penzel.

Often doctors will find two members of the same family with OCD who do not exhibit the same thoughts or behaviors. This leads them to believe that OCD behaviors aren't learned behaviors.

What Causes OCD?

Dr. Michael Liebowitz, director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute, describes serotonin as a “worry chemical in the brain. We have worry chemicals and worry centers, and it looks like people with OCD have too much of this worry chemical in certain parts of the brain. And the worry centers, such as the frontal lobes, seem to be going overtime.” This over-activity could be affecting the way people with OCD feel about such things as cleanliness (as in Andrea's case) and symmetry.

How Do I Know If I Have OCD?

Some common rituals associated with OCD are incessant hand washing, bathing, or showering. Many sufferers are obsessed with germs and contamination. Other aspects of the disorder include constant counting, checking, or arranging. Some people with OCD need to be constantly reassured that they haven't caused harm to others.

One reported case involved a man who would constantly drive back along the path he had driven to make sure he had not run over someone. Other people are “hoarders,” who save everything for fear that they might throw away something valuable.

The list below can help you identify the symptoms of OCD, although this isn't a substitute for seeing a doctor. Having some of the symptoms doesn't mean you have OCD. But when the behaviors interfere with your everyday life, you should consider seeing a doctor.

Are You Obsessive-Compulsive?

We tease a “compulsive” friend who keeps her CDs in alphabetical order or arranges her closets with military precision. We all know people “obsessed” with cooking or sports or gardening. Many people knock on wood for luck, or step over a sidewalk crack to avoid breaking their mother's back, or can't resist the urge to straighten every crooked picture on the wall. Such everyday habits and superstitions are not signs of obsessive-compulsive disorder - unless you become, well, compulsive about them.

Most cases of obsessive-compulsive disorder come on fairly suddenly and are impossible to ignore. People with milder forms of the disorder, however, may carry on normal lives after having devoted a number of hours each day to what Freud called their “secret doings” in the privacy of their homes. One study found that 37 percent of the patients who visited a dermatology clinic with nonspecific dermatitis were obsessive-compulsives who had brought on the condition by overzealous washing. Yet none had sought treatment for the disorder. Even without treatment, about 40 percent of patients are symptom-free or in fairly good shape at any given time.

The following is a list of the most common symptoms of the disease. The American Psychiatric Association says that garden-variety obsessions and compulsions cross over to a disorder only when they become severe enough to cause excessive anxiety, take up more than one hour of your time each day, or significantly alter your routine.

Constant checking and rechecking of whether appliances have been turned off or doors locked.

An overwhelming concern for order and tidiness.

Fear of contagion, leading to excessive washing.

Repetition of numbers, tunes, words, or sounds.

Fear of violent or aggressive actions toward oneself or others.

Intrusive sexual, offensive, or blasphemous thoughts

How Do I Know if My Child Has OCD?

If you or your child's teacher notice your child performing “strange” and repetitive rituals, or taking too much time to perform simple tasks, it's possible that he or she might have OCD. According to Dr. Penzel, many children with OCD have “problems with symmetry, ordering things, arranging them. They don't want anyone in their rooms or touching their possessions. They have things in a certain way and won't let them be disturbed.”

Some of the most common OCD behaviors found in children are “morbid obsessions, which usually center on harm coming to them or their parents, beyond the usual worries. Also, you see in children fears or thoughts of choking or throwing up,” Dr. Penzel says.

Treatment

The two forms of treatment for obsessive-compulsive disorder are behavior therapy and drugs. In many cases both treatments are used simultaneously, and this is considered by many to be the most effective way to treat the disorder.

Behavior therapy involves exposing patients to the things they fear and then keeping them from performing the rituals they would normally perform. For example, if a patient suffers from compulsive hand washing, the therapist would have the person get his or her hands dirty and not wash them for a certain period of time. If the treatment is effective, the anxiety of not being able to wash the hands will gradually decrease. The ritual of hand washing will also decrease.

According to the Harvard Medical School Health Letter, approximately “60 to 70 percent of people with OCD are very much improved after behavior therapy.”

A few drugs are being tested for the treatment of OCD. One is clomipramine, sold under the name Anafranil. As with many prescription drugs, clomipramine has side effects, which include dry mouth, constipation, and blurred vision. For many patients, it takes two or three months for the clomipramine to take effect. “Also,” states Dr. Penzel, “studies have shown that when people who rely solely on medication go off it, there is almost a 100 percent relapse rate. People generally did better in the long run who had had behavior therapy rather than just medication alone.”